Immigration Bill

Baroness Masham of Ilton Excerpts

Thursday 3rd April 2014 Lords Chamber

Moved by

[Baroness Masham of Ilton]

52: After Clause 38, insert the following new Clause—
“Exemption of charging for primary medical services where charging is not cost-effective or poses a risk to public health
(1) Section 182 of the National Health Service Act 2006 (remission and payment of charges) is amended as follows.
(2) After subsection (1), insert—
“(2) Insofar as any regulations under section 175 provide for charges to be made for the provision of primary medical services, they shall include provision for the remission in full of any charge that falls below the minimum threshold of service cost.
(3) In subsection (2), the “minimum threshold of service cost” shall be the cost to the provider of primary medical services below which no charge is to be made for the provision of those services.
(4) Where regulations under section 175 provide for a charge to be made for the provision of primary medical services, the provider of those services may waive the charge where he or she considers that the cost of recovering the charge is not economical or where the consequences of charging may put the public health at risk.””

[Baroness Masham of Ilton (CB)]

My Lords, Amendment 52 is to do with public health protection. In Committee, the noble Baroness, Lady Cumberlege, spoke to this amendment, for which I was very grateful as unfortunately I had a long-standing commitment which I had to attend. The noble Baroness, like me, is passionate about health safety and knows that the Bill may cause danger to the health of the nation. Some people who have not paid the health levy may not seek help when they become ill because they fear being reported to the authorities and they may not have the money for tests and medication.

I am particularly concerned because, with the resistance to antibiotics and antivirals, diseases may be spread when people leave treatment too late. If they think they have to pay for medication, they will not go to primary healthcare for diagnosis. What will be the point?

As it is, it is very difficult to find some homeless people who need screening and I congratulate the organisation Find and Treat. I thank both Ministers for the recent meeting we had with the noble Lord, Lord Taylor of Holbeach, and the noble Earl, Lord Howe. It is important that departments work together over this complex matter with Public Health England. This amendment is to do with public health and cost-effectiveness.

I declare an interest as an officer of the APPG on Primary Care and Public Health and the groups on HIV and tuberculosis.

The purpose of the amendment is to provide an exemption from NHS charges where the cost of imposing and recovering a charge is not cost-effective or where the imposition of a charge constitutes a risk to public health. Doctors of the World supports this amendment, as do other health organisations.

In its response to last year’s consultation, the Royal College of General Practitioners made clear that it,

“opposes any change to the eligibility rules for migrants accessing GP services”.

Among the reasons given for its opposition were risks to public health and the imposition of new administrative burdens. Dr Mark Porter, the chair of the BMA council, has described the proposed charges as, “impractical, uneconomic and inefficient”. The Academy of Medical Royal Colleges emphasised in its response to the consultation that any proposals adopted,

“should not … create a bureaucratic process and burden that outweighs any tangible benefits”.

The amendment does not prevent charging but provides some flexibility within the proposed system to make it more cost-effective. The requirement to set a,

“minimum threshold of service cost”,

introduced in proposed new subsections (2) and (3) of Section 182 of the National Health Service Act 2006, achieves this. It requires the Secretary of State to stipulate a figure in regulations. If the cost of providing primary care falls below the stipulated figure, there is to be no charge. Similarly, if the provider of primary care considers that it will not be cost-effective to recover the charge, the provider may waive the charge. This would be achieved by the amendment in proposed new subsection (4) to Section 182 of the National Health Service Act 2006. Section 182 concerns exemptions from charges, including NHS charges to be made under Section 175, to which Clause 34(2) of the Bill refers. To this extent, the amendment responds to the concerns of the Royal College of General Practitioners, the BMA council and the Academy of Medical Royal Colleges. The Department of Health has acknowledged that,

“the administrative cost may outweigh the recoverable charges for frequently used but relatively inexpensive services”.

--- Later in debate ---

[Lord Taylor of Holbeach]

My Lords, I agree that this is a very useful opportunity to inform the House of where we are on this issue. The noble Baroness, Lady Masham, will understand that the provisions in the Bill are one thing and the wider provisions for implementing health service charging are another. We had a really useful meeting with my noble friend Lord Howe where a number of noble Lords present came to talk about this issue. I think noble Lords will agree he is very much focused on the full implications of any changes. I reassure the noble Earl, Lord Sandwich, that Médecins du Monde corresponds with me on a fairly regular basis so I know what its concerns are and unfortunately it was not at the meeting with the noble Earl, Lord Howe. If it had been I think it would have understood better the way in which the health service reforms were being taken forward. The other thing which it would certainly have picked up is that it is absolutely clear that treatment for infectious public health conditions is free to all and will remain so. We should just make that clear; I hope that it reassures my noble friend Lady Williams and the noble Baroness, Lady Masham.

As we discussed at length when we were talking about this issue, any exemptions from the NHS charging of short-term visitors and illegal migrants are not really a matter for the Home Office. This is not a provision that is being enacted in the Bill and is not a question on which the Home Office would make a decision. Exemptions are a matter for the Department of Health. I know that they are being considered very sensitively. Let us not forget that, within the devolved remit, while there is one United Kingdom for immigration purposes there are four national health services within the United Kingdom. It is not for me from this Dispatch Box to speak on their behalf. I have no wish to cause a constitutional crisis by inadvertently taking over responsibilities for which I have no responsibility.

My noble friend Lord Howe has agreed to meet again with noble Lords. I think that everybody felt that that was a helpful meeting. I want to keep everybody in the loop; I can act as a facilitator in this respect. When my noble friend’s department has developed more detailed proposals for reforming NHS overseas visitor charging arrangements—and it is that charging which is being looked at in particular, for people on short visits here—this will provide the appropriate time and context for discussions on the NHS charging arrangements for these groups.

Going back to the beginning, I confirm that treatment for infectious public health conditions is free for all and will remain so. I hope that that is a big reassurance. Given that reassurance, alongside our existing commitment that GP and nurse consultations will remain free to all and that that is not limited to the first consultation, I hope that the noble Baroness will indeed withdraw her amendment. I look forward to having further discussions with her and my noble friend Lord Howe in the future.

[Baroness Masham of Ilton]

My Lords, I thank the Minister and all who have supported the amendment. What is confusing is that Clauses 37 and 38 cover the new charges and restrictions of healthcare access in this Bill. Therefore, it is surely an immigration and health matter. Therefore, unless there is a combination working together on this complex matter, there will be confusion and people may fall through the net. I hope that I have helped to get the message across that public health and protection are vital, especially when dealing with vulnerable people. I beg leave to withdraw the amendment.

Amendment 52 withdrawn.